Saturday, July 13, 2013

Stage 1 Follicular Lymphoma

I don't know how much this applies to most people who read Lympho Bob, but it's interesting nonetheless: some research from France on the impact of the choice of initial therapy on  Stage 1 Follicular Lymphoma patients.

Stage 1 Follicular Lymphoma describes patients who have been diagnosed with FL in one location -- a single cluster of lymph nodes, maybe under one arm. It's pretty rare to be diagnosed so early; the numbers I usually see say something like 10% of patients are diagnosed at stage 1. Most of us are at stage 3 or 4 -- involvement at multiple sites, above and below the diaphragm, maybe some organ involvement, too. Staging for Follicular Lymphoma isn't as important as it is for solid cancers. The same treatments are likely to work for stage 4 as for any other stage. Staging is about location more than intensity.

Except with stage 1. Traditionally, stage 1 Follicular Lymphoma is the one type that's thought to be curable. Because it is isolated to one area, it can often be treated with traditional radiation, and sometimes is cured.

This article looks at whether or not radiation is still the best option. No one has really revisited that since Rituxan became popular.

The researchers looked at 145 FL patients with stage 1 or 2 disease, and divided them into 6 groups, based on the treatment they received: 1) watching and waiting, 2) chemotherapy, 3) radiation, 4) radiation + chemo, 5) Rituxan, and 6) Rituxan + chemo.

The results were kind of mixed, in my opinion (and the abstract kind of fudges things a bit). While Rituxan had the lowest Complete Response rate (57%), and Radiation + Chemo had the highest CR (94.7%), both groups had the highest overall response rate -- 100%. But Radiation + chemo had a high relapse rate (84%), second only to straight radiation (90.5%). Rituxan's was 42.9%.

Their conclusion is that none of this seems to affect Overall Survival. Even the watching and waiting group had the same OS as everyone else -- pretty much in line with other studies, no matter what the stage.

Radiation might give people a shot at a cure, but if it doesn't work, it's not going to help them any more in the long run than if they'd just watched and waited.

These kinds of retrospective studies -- looking back at a group of patients -- are interesting, but they seem kind of misplaced at this point. They started long ago, I know, so they need to be finished and results need to be reported. But when the conclusion reads that immunochemotherapy [that is, Rituxan + chemo] is the best option when treatment is necessary, I think it speaks to some old-school thinking. I'd like to see people at least make a nod to some of the exciting stuff that's happening these days.

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